Comparison of short-term outcomes of thrombolysis for in-hospital stroke and out-of-hospital stroke in United States.
Comparison of short-term outcomes of thrombolysis for in-hospital stroke and out-of-hospital stroke in United States.
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DOI：
10.1161/strokeaha.113.000945
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发表时间：
2013-07
期刊：
影响因子：
8.3
通讯作者：
Levine SR
中科院分区：
文献类型：
--
作者：
Moradiya Y;Levine SR
院内卒中（IHS）不同于院外卒中（OHS）的危险因素和结果。我们在一项横断面研究中比较了来自大型国家队列的溶栓治疗的IHS和OHS，以进一步阐明这些差异。在2005年至2010年的全国住院患者样本中搜索了接受静脉或动脉溶栓治疗的成人急性缺血性卒中病例。入院当天接受治疗的患者被归类为OHS。我们比较了栓溶his和OHS的人口学和医院特征、合并症和短期结果。在本研究纳入的11,750例血栓溶解性卒中病例中，IHS占8.7%。与OHS相比，IHS与更高的合并症和更高的急性医疗状况发生率相关。IHS有较高的住院死亡率（15.7%比9.6%，P<0.001）和较低的出院率（22.8%比30.0%，P<0.001）。IHS也与血管内治疗组较高的死亡率相关（19.3% vs 13.8%； P=0.010）。两组脑出血发生率差异无统计学意义（5.3% vs 4.7%； P=0.361）。在多因素分析中，IHS患者的住院死亡率（校正OR为1.59；95% CI为1.32-1.92；P<0.001）和出院预后良好（校正OR为0.79；95% CI为0.67-0.93；P=0.005）仍然明显较差。与血栓溶出的OHS相比，血栓溶出的IHS与更差的出院结果相关，可能是由于其更高的合并症和入院的其他医疗原因。在IHS患者中，溶栓与较高的脑出血发生率无关。
In-hospital stroke (IHS) differs from out-of-hospital stroke (OHS) in risk factors and outcomes. We compared IHS and OHS treated with thrombolysis from a large national cohort in a cross-sectional study to further clarify these differences. The Nationwide Inpatient Sample for the years 2005 through 2010 was searched for adult acute ischemic stroke cases treated with intravenous or intra-arterial thrombolysis. Patients treated on the day of admission were classified as OHS. We compared the demographic and hospital characteristics, comorbidities, and short-term outcomes of thrombolysed IHS and OHS. IHS represented 8.7% of 11,750 thrombolysed stroke cases included in this study. IHS was associated with a higher comorbidity profile and higher rates of acute medical conditions compared to OHS. IHS had higher inpatient mortality (15.7% versus 9.6%; P<0.001) and lower rate of discharge to home/self-care (22.8% versus 30.0%; P<0.001). IHS was also associated with higher mortality among endovascular treatment group (19.3% versus 13.8%; P=0.010). The difference in the rate of all intracerebral hemorrhage (ICH) was not significant (5.3% versus 4.7%; P=0.361). In the multivariate analysis, inpatient mortality (adjusted OR, 1.59; 95% CI, 1.32–1.92; P<0.001) and favorable discharge outcome (adjusted OR, 0.79; 95% CI, 0.67–0.93; P=0.005) remained significantly worse in IHS. Thrombolysed IHS is associated with worse discharge outcomes compared to thrombolysed OHS, likely due to their higher comorbidities and additional medical reasons for the index admission. Thrombolysis is not associated with a higher rate of ICH among IHS.